Myrna C. Jackson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

04710 Issued in MD

Practice address

200 E. North Ave
Related Services RM 210
Baltimore, MD 21202

Phone

(443) 642-4211

NPI assigned

Jun 11, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1043879315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HAMLET HILL RD UNIT 602",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212101510",
            "telephone_number": "410-913-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E. NORTH AVE",
            "address_2": "RELATED SERVICES RM 210",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21202",
            "telephone_number": "443-642-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MYRNA",
        "middle_name": "C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "04710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mcjackson@bcps.k12.md.us",
            "affiliation": "N",
            "address_1": "200 E. North Ave",
            "address_2": "Related Services Rm 210",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "21202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew Jackson, D.O.
• Matthew Jackson, MD
• Mia Jackson
• Miraya Jackson, LMSW
• Montess Thorne Jackson
• Niya Danielle Jackson
• Olander B. Jackson
• Onestie Sabine Jackson, BCBA
• Pattie D. Jackson, LCSW-C
• Phillip Anthony Jackson Jr., CRNP

• Clinical Social Worker in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.